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      The effect of the progressive muscle relaxation combined withs lavender aromatherapy on insomnia of hemodialysis patients Translated title: El efecto de la relajación muscular progresiva combinado con la aromaterapia de lavanda sobre el insomnio de los pacientes en hemodiálisis

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          Abstract

          Abstract Introduction: Insomnia is the much common sleep disorder in hemodialysis patients, which will cause a decrease in quality of life. Aromatherapy combined with progressive muscle relaxation are expected to increase the effects of relaxation on the patient so that the patient's sleep quality can improve optimally. Objective: The study aimed to investigate the effect of the progressive muscle relaxation combined with lavender aromatherapy on insomnia among patients undergoing hemodialysis. Material and Methods: The design of this study included a quasi-experiment with a pretest-posttest control group approach. The sample selection was performed using a consecutive sampling technique and involved 50 respondents, divided into two equal control and study group. Patients in study group recommended to do progressive muscle relaxation at least four times per week for three weeks and were told to drop two - three drops lavender aromatherapy on a pillow 30 minutes before bedtime at least 4 nights per week for three weeks. The control group recommended to do muscle relaxation and daily routine care at least four times per week for three weeks. Results: The results showed that both study and control groups were equal in terms of demographics, and scores of insomnia at the baseline. There no significant difference between the mean insomnia scores of two group before intervention, while the difference was statistically significant after the intervention. The mean insomnia scores were lower in study group than in the control group. Conclusion: Progressive muscle relaxation and lavender aromatherapy were effective in decreasing insomnia scores among patients undergoing hemodialysis.

          Translated abstract

          Resumen Introducción: El insomnio es el trastorno del sueño más común en los pacientes en hemodiálisis, que provoca una disminución de la calidad de vida. Se espera que la aromaterapia combinada con relajación muscular progresiva aumente los efectos de la relajación en el paciente para que así la calidad del sueño del paciente pueda mejorar de manera óptima. Objetivo: Investigar el efecto de la relajación muscular progresiva combinada con aromaterapia de lavanda sobre el insomnio en pacientes sometidos a hemodiálisis. Material y Método: Se utilizó un diseño pretest y posttest cuasi-experimental con grupo de control. La selección de la muestra se realizó mediante una técnica de muestreo consecutivo e involucró a 50 encuestados, divididos en dos grupos iguales. Al grupo de estudio se le recomendó hacer relajación muscular progresiva al menos cuatro veces por semana durante tres semanas y que pusieran dos o tres gotas de aromaterapia de lavanda en una almohada 30 minutos antes de acostarse al menos cuatro noches por semana durante tres semanas. Al grupo control se le recomendó realizar relajación muscular y cuidados diarios rutinarios al menos cuatro veces por semana durante tres semanas. Resultados: Los grupos de estudio y control fueron iguales en términos demográficos y puntuaciones de insomnio al inicio del estudio. No hubo diferencias significativas entre las puntuaciones medias de insomnio para los dos grupos antes de la intervención, mientras que la diferencia fue estadísticamente significativa tras la intervención. Las puntuaciones medias de insomnio fueron más bajas en el grupo de estudio que en el grupo de control. Conclusión: La relajación muscular progresiva y la aromaterapia de lavanda fueron efectivas para disminuir las puntuaciones de insomnio entre los pacientes sometidos a hemodiálisis.

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          Most cited references34

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          The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response.

          Although insomnia is a prevalent complaint with significant morbidity, it often remains unrecognized and untreated. Brief and valid instruments are needed both for screening and outcome assessment. This study examined psychometric indices of the Insomnia Severity Index (ISI) to detect cases of insomnia in a population-based sample and to evaluate treatment response in a clinical sample. Participants were 959 individuals selected from the community for an epidemiological study of insomnia (Community sample) and 183 individuals evaluated for insomnia treatment and 62 controls without insomnia (Clinical sample). They completed the ISI and several measures of sleep quality, fatigue, psychological symptoms, and quality of life; those in the Clinical sample also completed sleep diaries, polysomnography, and interviews to validate their insomnia/good sleep status and assess treatment response. In addition to standard psychometric indices of reliability and validity, item response theory analyses were computed to examine ISI item response patterns. Receiver operating curves were used to derive optimal cutoff scores for case identification and to quantify the minimally important changes in relation to global improvement ratings obtained by an independent assessor. ISI internal consistency was excellent for both samples (Cronbach α of 0.90 and 0.91). Item response analyses revealed adequate discriminatory capacity for 5 of the 7 items. Convergent validity was supported by significant correlations between total ISI score and measures of fatigue, quality of life, anxiety, and depression. A cutoff score of 10 was optimal (86.1% sensitivity and 87.7% specificity) for detecting insomnia cases in the community sample. In the clinical sample, a change score of -8.4 points (95% CI: -7.1, -9.4) was associated with moderate improvement as rated by an independent assessor after treatment. These findings provide further evidence that the ISI is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.
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            Insomnia in the Elderly: A Review

            Background: Insomnia remains one of the most common sleep disorders encountered in the geriatric clinic population, frequently characterized by the subjective complaint of difficulty falling or maintaining sleep, or nonrestorative sleep, producing significant daytime symptoms including difficulty concentrating and mood disturbances. Methods: A search of the literature was conducted to review the epidemiology, definition, and age-related changes in sleep, as well as factors contributing to late-life insomnia and scales utilized for the assessment of insomnia in older people. The aim is to summarize recent diagnostic guidelines and both nonpharmacological and pharmacological strategies for the management of insomnia in the older population. Results: Insomnia remains a clinical diagnosis. There are several demographic, psychosocial, biologic, and behavioral factors that can contribute to late-life insomnia. Older adults are at higher risk for the medical and psychiatric effects of insomnia. Conclusions: The most important aspect in evaluation of insomnia is detailed history taking and thorough physical examination. Nonpharmacological treatment options have favorable and enduring benefits compared to pharmacological therapy. Citation: Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. J Clin Sleep Med. 2018;14(6):1017–1024.
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              A Brainstem-Spinal Cord Inhibitory Circuit for Mechanical Pain Modulation by GABA and Enkephalins.

              Pain thresholds are, in part, set as a function of emotional and internal states by descending modulation of nociceptive transmission in the spinal cord. Neurons of the rostral ventromedial medulla (RVM) are thought to critically contribute to this process; however, the neural circuits and synaptic mechanisms by which distinct populations of RVM neurons facilitate or diminish pain remain elusive. Here we used in vivo opto/chemogenetic manipulations and trans-synaptic tracing of genetically identified dorsal horn and RVM neurons to uncover an RVM-spinal cord-primary afferent circuit controlling pain thresholds. Unexpectedly, we found that RVM GABAergic neurons facilitate mechanical pain by inhibiting dorsal horn enkephalinergic/GABAergic interneurons. We further demonstrate that these interneurons gate sensory inputs and control pain through temporally coordinated enkephalin- and GABA-mediated presynaptic inhibition of somatosensory neurons. Our results uncover a descending disynaptic inhibitory circuit that facilitates mechanical pain, is engaged during stress, and could be targeted to establish higher pain thresholds. VIDEO ABSTRACT.
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                Author and article information

                Journal
                enefro
                Enfermería Nefrológica
                Enferm Nefrol
                Sociedad Española de Enfermería Nefrológica (Madrid, Madrid, Spain )
                2254-2884
                2255-3517
                April 2021
                : 24
                : 1
                : 39-46
                Affiliations
                [1] West Java orgnamePoltekkes Kemenkes Tasikmalaya orgdiv1Department of Nursing Indonesia
                Article
                S2254-28842021000100004 S2254-2884(21)02400100004
                10.37551/s2254-28842021004
                e903fb72-8926-4cdd-b541-4f28461d5641

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 15 December 2020
                : 23 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 8
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                SciELO Spain

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                relajación muscular progresiva,insomnia,insomnio,aromaterapia,pacientes en hemodiálisis,aromatherapy,hemodialysis patients,progressive muscle relaxation

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